Craniofacial dental orthodontics is the complex subspecialty that involves a multidisciplinary team of dental, surgical, and medical subspecialists treating patients with birth defects such as cleft lip and cleft palate. Orthognathic surgery or corrective jaw surgery is a specialty of the Craniofacial Team of Texas.
Craniofacial Dental Orthodontics (Braces) for Cleft Lip and Palate and Craniofacial Disorders
Craniofacial Dental Orthodontics is the subspecialty of orthodontics that focuses on the multidisciplinary treatment of patients with birth defects such as cleft lip and palate. These conditions often require coordinated surgical and medical interventions or extraordinary behavioral management to make orthodontic treatments practical and effective. Braces/orthodontic treatment for cleft lip and palate patients tends to be more complex, takes more time and clinical resources, and requires working with multiple dental, surgical, and medical providers to get the best results. Current practice standards call for a coordinated plan of care between the trained craniofacial orthodontists and plastic-craniofacial surgeons — among other specialists — to achieve excellent and aesthetic facial results.
Treating patients with cleft lip and palate is commonly done in a team setting and usually spans the first two decades of life. Craniofacial dental orthodontists have the experience and education necessary to deliver cleft lip and palate treatments. We have clinical expertise in all aspects of orthodontic braces treatment for infants, children, adolescents, and adults with facial clefts, craniofacial diagnoses, and complex medical and special needs. Our doctors and staff are experienced and confident when working with patients that require craniofacial and special care treatments.
Patients and parents may access additional resources related to these conditions by visiting the website for the American Cleft Palate-Craniofacial Association (ACPA). The ACPA reports that patients born with birth defects benefit the most when all providers work together in interdisciplinary or multidisciplinary teams, ensuring not only the best outcome, but also the most effective utilization of health resources. You may download the brochure listing the Parameters for Evaluation and Treatmentof Patients with Cleft Lip/Palate or Other Craniofacial Anomalies.
Medical Necessity for Craniofacial Dental Orthodontic Services
Patients with cleft and craniofacial anomalies require orthodontic services as a direct result of the medical condition and as an integral part of the rehabilitative process. Orthodontic care is given to achieve the best aesthetics, function, and stability of a child’s bite. This treatment may include traditional braces, orthopedic appliances designed to affect growth of the jaws, or simple removable appliances.
Since facial growth is an important aspect of orthodontic care, the first orthodontic evaluation may take place even before the child has any teeth. As the baby teeth, and later the permanent teeth, begin to erupt, the orthodontist monitors the child’s dental and facial development, and intervenes with treatment when necessary. Thus, it is not unusual for a child with a cleft to have two or even three carefully planned phases of treatment. In some cases, orthodontic treatment may be necessary in all three stages.
Craniofacial Dental Orthodontics treatment often takes place in phases which may include:
- Treatment in infancy (in the form of appliances such as NAM)
- The primary dentition (baby teeth only)
- The transitional dentition (baby and permanent teeth)
- The permanent dentition
Each orthodontic treatment phase will have specific goals, and in between phases, appliances are removed. Each stage of therapy may be followed by orthodontic retention and regular observation; the orthodontic retention period for the permanent dentition may extend into adulthood.
The Newborn Phase – NAM (Nasoalveolar Molding)
NAM is a non-surgical technique of molding the soft tissues of the lip and the nose to decrease the cleft deformity prior to the first surgery to close the lip. NAM treatment also approximates the alveolar cleft segments to decrease the cleft space. It is thought to facilitate the initial lip surgery and decrease scar formation, thus improving nasal deformity and facial appearance in the early childhood years.
The Childhood Years – Phase I Dental Braces
Craniofacial Dental Orthodontics requires the coordination between the surgeon and the orthodontist, which becomes most important in the management of the bony defect in the upper jaw that may result from the cleft. Reconstruction of the cleft defect may be accomplished with a surgery (bone graft) performed by the surgeon. The orthodontist may place an appliance and braces on the teeth of the upper jaw to prepare for the bone graft. A retainer is usually placed after the bone graft until full braces are applied. Surgical splints may be needed during surgery.
The Teenage Years and Beyond – Phase II or III Dental Braces
When the child approaches adolescence, dental braces are needed again to correct teeth positions and finalize the bite. The orthodontist and the surgeon again coordinate their efforts if the teeth do not meet properly because the jaws are in abnormal positions. If the tooth relations cannot be made normal by orthodontics alone, a combined approach of both orthodontics and surgical repositioning of the jaws is necessary. Such surgery is usually preformed after the pubertal growth spurt is completed. Distraction osteogenesis can be performed before growth is completed and have demonstrated to be effective early on when children are in early permanent dentition. Additional jaw surgery may be needed if growth occurs after distraction. However, the amount of bone created by distraction and improved function are greatly enhanced, with relapse being minimized.
Children with cleft lip and/or palate require the coordinated care of a number of specialists. For this reason, care of these patients should be rendered by the Craniofacial Team of Texas. At such team evaluations, treatment planning and care are provided by an experienced multidisciplinary team composed of representatives from a variety of dental, medical, and other health care specialties. The care of the cleft/craniofacial child will receive in such a center may be well worth the inconvenience of traveling to Austin for medical or surgical treatment.
Please contact the Craniofacial Team of Texas if you would like to schedule an appointment.
If you would like more information about Craniofacial Dental Orthodontics, please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.